Methods and compositions for treating lupus

ABSTRACT

The invention relates to compositions and methods for treating lupus. The methods typically comprise the step of administrating one or more compounds selected from isoindigo, indigo, indirubin, or derivatives thereof, such as, Meisoindigo and NATURA in an amount sufficient to treat the lupus; preferably by modulating cytokine expression. Preferably the compound is in an amount less than sufficient to substantially inhibit cyclin dependent kinases.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/197,164, filed Aug. 3, 2011, now U.S. Pat. No. 8,748,475, which is acontinuation-in-part of U.S. patent application Ser. No. 12/972,908,filed Dec. 20, 2010, now U.S. Pat. No. 8,563,525, which is acontinuation-in-part of U.S. patent application Ser. No. 11/494,362,filed Jul. 26, 2006, now U.S. Pat. No. 7,855,223, which is acontinuation-in-part of U.S. patent application Ser. No. 10/754,547,filed Jan. 12, 2004, abandoned, the contents of each of which are hereinincorporated by reference for all purposes.

INCORPORATION-BY-REFERENCE OF MATERIAL ELECTRONICALLY FILED

Incorporated by reference in its entirety herein is a computer-readablenucleotide/amino acid sequence listing submitted concurrently herewithand identified as follows: One 1,322 kilobyte ASCII (text) file named“Seq_List” created on Aug. 13, 2014.

TECHNICAL FIELD

The invention relates to pharmaceutical compositions and methods oftreating lupus. The method typically comprises administration of one ormore compounds selected from isoindigo, indigo, indirubin, orderivatives thereof, such as, Meisoindigo and NATURA.

BACKGROUND OF THE INVENTION

Lupus is a chronic and prototypical systemic autoimmune diseasecharacterized by multisystem microvascular inflammation leading to organdamage as a result of loss of tolerance to self-antigens [1-4]. Symptomsof lupus can occur in any part of the body, including the skin, heart,lungs, kidneys, joints and/or nervous system. Lupus may also be causedby a hypersensitive reaction to a medication.

The prevalence of lupus varies among geography regions and races fromapproximately 40 per 100,000 persons in Northern Europeans to more than200 per 100,000 persons among blacks. In the United States, the numberof patients with lupus is over 250,000 [2]. It is more frequent inAfrican, Japanese and Chinese. The exact cause of lupus remains unknown,various factors including genetic, racial, hormonal, and environmentalfactors have been associated with the development of the disease [2, 5].It is estimated that women are eight times more likely to develop eitherdiscoid or systemic lupus than men are. While the disease can people ofall ages, including newborns and even the fetus, it usually develops inindividuals who are 20 to 45 years old. Infections, renal failure, andcardiovascular diseases account for the majority of deaths as a resultof lupus.

Although lupus is an autoimmune disease, its heterogeneous nature makesthe exact mechanisms for its development unclear. There is currently nocure for lupus. Current treatments only focus on alleviating thesymptoms, rather than the cause. These treatments include 1)anti-inflammatory medications (such as ibuprofen), 2) high doses ofcorticosteroids, and 3) immunosuppressants, such as methotrixate. Whiletoxicities can become significant because of long-term maintenancetherapy required, the disease eventually progresses to end-stagemultiple organ damages and death. Although recent extensive studies haveenriched our knowledge in understanding molecular pathogenesis of lupus,development of therapies for lupus has largely lagged. Despite itsmoderate efficacy, belimumab (Benlysta®) is the only new drug approvedrecently by FDA for treatment of lupus in over 50 years. Belimumab is aninjectable monoclonal antibody designed to target B-lymphocytestimulator BLyS protein, and to relieve flare-ups and pain caused bylupus, which may reduce the number of abnormal B cells thought to be aproblem in lupus. Therefore, a new effective treatment of lupus ishighly desired.

A need exists for a treatment for lupus that is effective and preferablytreating the cause and not just the symptoms of the disease.

SUMMARY OF THE INVENTION

The invention is directed to a method of treating an animal with lupus.The method preferably comprises the step of administering to the animalin need of such treatment at least one compound selected from the groupof Meisoindigo, tri-acetylated glycol-Meisoindigo (prodrug), or NATURA,wherein the composition is administered in an amount sufficient to treatlupus. Advantageously, the method may also be used to treat an animalwith nephritis. In a preferred embodiment, the amount of compoundadministered is sufficient to inhibit pro-inflammatory cytokineexpression and/or stimulate anti-inflammatory cytokine expression, butless than sufficient to substantially inhibit cyclin dependent kinases.

Preferably, the compound is administered in an amount sufficient toinhibit at least one of IL-1α, β, IL-2, IL-3, IL-6, IL-7, IL-9, IL-12,IL-17, IL-18, TNF-α, LT, LIF, Oncostatin, or IFNc1α, β, γ. In anotherembodiment, the compound is administered in an amount sufficient tostimulate at least one of IL-4, IL-10, IL-11, W-13 or TGFβ. And in amost preferred embodiment, the compound is administered in an amountsufficient to modulate cytokines TNF-α, IL-1β, IL-6, and IL-10.Advantageously, the compound may be administered in an amount sufficientto reduce proteinuria levels and/or modulate a humoral response.

Quantitatively, the amount administered is preferably less than 0.36mmol/kg per day, and preferably between 0.036 mmol/kg and 0.288 mmol/kgper day. When the compound administered is Meisoindigo, the amountadministered is preferably less than 100 mg/kg per day, and morepreferably between 10 mg/kg and 80 mg/kg per day.

In an alternative embodiment, the method comprises the step ofadministering a first and second compound to an animal in need oftreatment for lupus. Preferably, the first compound is Meisoindigo,tri-acetylated glycol-Meisoindigo (prodrug), or NATURA, and the secondcompound is selected from the group consisting an anti-inflammatoryagent, corticosteroid, immune suppressant, or biologic drug.

The invention also pertains to a composition for treating lupus and/ornephritis. These composition typically comprise an active compound, anagent, and a pharmaceutically acceptable carrier. In this embodiment,the active compound is selected from the group consisting ofMeisoindigo, tri-acetylated glycol-Meisoindigo (prodrug), or NATURA, andthe agent is selected from the group consisting of an anti-inflammatoryagent, corticosteroid, immune suppressant, or biologic drug.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic representation of mechanisms of Meisoindigo intreating autoimmune disease: Th17 cells are a major driving force oflupus through pro-inflammatory cytokines such as IL-17A, IL-17F andIL-21 as well as others. Under normal physiological conditions, activityof Th17 cells is well balanced by the activity of anti-inflammatory Tregcells. Autoimmune diseases will occur when the balance is skewed.Meisoindigo (Natura-α) inhibits proliferation/differentiation of Th17through repression of inflammatory cytokines such as, IL-β, IL-6, TNF-αin innate immune cells, such as monocytes; while promotingdifferentiation of Tregs and shifting a Th1 response to a Th2 response.

FIG. 2 shows the effect of Meisoindigo on the secretion of IL-1β in LPSstimulated human monocytic THP-1 cells Inhibitory effect of Meisoindigoon IL-1β production in LPS-stimulated human monocytic THP-1 cells. TheTHP-1 cells were treated/stimulated with and without 1 μg oflipopolysaccharide (LPS, Sigma), and exposed for 24 hrs to a series ofconcentrations of Meisoindigo (from 31.25 nM to 16,000 nM). Viability ofcells was examined under the microscope after trypan blue staining.Protein levels of IL-1β secreted into the culture media were measured byELISA and calculated from its standard curve (panel A) using an assayKit from R&D Systems as described in Materials and Methods in Example 1below. The student t-test was used to determine the statisticallysignificance, *** indicates P<0.001. As shown in panel B, Meisoindigosignificantly inhibits IL-1β production at concentration as low as 31nM.

FIG. 3 shows the effect of Meisoindigo on the secretion and expressionof IL-6 in LPS stimulated human monocytic THP-1 cells. Effects ofMeisoindigo on the production (panel B) and transcription (panel C) ofIL-6 in LPS-stimulated THP-1 cells: THP-1 cells were treated/stimulatedwith and without 1.0 μg/ml of LPS and exposed to a series ofconcentrations of Meisoindigo (from 0.031 to 16 μM) for 24 hrs. The IL-6protein in the media was measured by ELISA, and the IL-6 transcriptionin cells was measured by real time PCR as described in Materials andMethods in Example 2 below. Panel A: Standard curve established usingthe pure IL-6 protein and used for the calculation of the proteinproduction in panel B; Panel C: real time PCR assay for thetranscription of IL-6. ***: P<0.001. As shown in panel B and C,Meisoindigo significantly inhibits both secretion and transcription ofIL-6.

FIG. 4 shows the effect of Meisoindigo on TNF-α secretion and expressionin human monocytic THP-1 cells. Effects of Meisoindigo on the proteinproduction (panel B) and gene transcription (panel C) of TNF-α inLPS-stimulated THP-1 cells: THP-1 cells were treated/stimulated with andwithout 1.0 μg/ml of LPS and exposed to a series of concentrations ofMeisoindigo (from 0.031 to 16 μM) for 24 hrs. The TNF-α protein in themedia was measured by ELISA, and its transcription in cells was measuredby real time PCR technology as described in Materials and Methods inExample 3 below. Panel A: Standard curve established using the pureTNF-α protein and used for the calculation of the protein production inpanel B. A concentration-dependent inhibition of Meisoindigo on TNF-αsecretion was obtained (panel B). Panel C: real time PCR assay for thetranscription of TNF-α. No effect of the agent on TNF-α transcriptionwas observed. ***: P<0.001.

FIG. 5 shows stimulation of IL-10 by Meisoindigo in THP-1 cells.Stimulation of Meisoindigo on the production of IL-10 in LPS-treatedTHP-1 cells: THP-1 cells were treated with and without 1.0 μg/ml of LPSand exposed to a series of concentrations of Meisoindigo (from 0.031 to16 μM) for 24 hrs. The IL-10 protein in the media was measured by ELISAas described in Materials and Methods in Example 4 below. Panel A:Standard curve established using the pure IL-10 protein and was used forthe calculation of the protein production in panel B. While inflammatorystimulant LPS decreased the protein level of IL-10, Meisoindigosignificantly increased the protein production, and the maximalstimulation effect occurred at 62.5 nM with approximately 2-foldincrease of IL-10 secretion (panel B). **: P<0.01.

FIG. 6 shows the effects of Meisoindigo and NATURA on the Expression ofPro-inflammatory Cytokines and Cyclin-dependent Kinases in THP-1 cells:The THP-1 cells grown exponentially were stimulated with (panel A and B)and without (panel C) 1 μg LPS, and exposed for 24 hrs to the indicatedconcentrations of Meisoindigo or NATURA. Viability of cells was examinedby trypan blue exception assay. Protein levels of IL-1β, IL-6 and IL-10secreted into the culture media were measured by ELISA as described inthe above examples using an assay Kit from R&D Systems as described inMaterials and Methods of Example 5 below. The student t-test was used todetermine the statistically significance, * indicates P<0.001.Meisoindigo and NATURA significantly inhibit production of IL-1β andIL-6, and promoted production of IL-10 at concentrations of 31.25 and62.5 nM. In contrast, no inhibitory effect of the compounds on CDK2 wasobserved at the low concentrations (31.25 and 62.50 nM) under sameexperimental conditions.

FIG. 7 shows the effects of Meisoindigo and Natura on proteinuria inNZB/W f1 mice. Beginning at 16 weeks of age, lupus progression of themice was monitored weekly by assessing proteinuria. A cohort of mice,selected at 17 weeks of age, served as the ‘asymptomatic normal’ group.At week 19, proteinuria (>30 mg/dL) was detected at 2 consecutiveoccasions, and the expected kidney damage was initiated (glomerularlesion >24%), the diseased mice were randomly divided into 5 groups(n=10). Group one animals were served as control (orally given vehicleonly). Group 2 and 3 animals were given Meisoindigo suspension orally bygavage at doses of 25 mg/kg (0.09 mmol/kg) and 75 mg/kg (0.272 mmol/kg),once a day, 5 days per week for 25 weeks. Group 4 and 5 animals weregiven Natura suspension orally at equal molar doses as Meisoindigoabove, i.e. 47 and 142 mg/kg, respectively, for the same period of time.Mice were monitored weekly for proteinuria until 44 weeks of age. Urinewas collected into a sterile container and assayed for the presence ofprotein (specifically albumin) using a colorimetric method (AlbustixReagent Strips, Bayer Corporation, Elkhart, Ind.).

FIG. 8 shows the survival rates of NZB/W f1 treated with Meisoindigo(low: 0.09 mmol/kg and hi: 0.272 mmol/kg), or with equal mol doses ofNatura or with vehicle or no treatment for 29 weeks. The animal survivalwas monitored daily. All animals in Meisoindigo treated groups survivedwhereas 80% animal survived in Natura treated groups, but only 40 to 50%animals survived in vehicle treated or not treated groups (p<0.001).

FIG. 9 shows changes in renal damages of NZB/W f1 mice treated withMeisoindigo (low: 0.09 mmol/kg; hi: 0.272 mmol/kg) or with equal moldoses of Natura or with vehicle. Kidneys were obtained from sacrificedmice during above treatments or from dead mice during the treatments.One-half of a kidney was fixed by overnight immersion in 10%formaldehyde and paraffin embedded. Kidney sections were stained with H& E and periodic acid-Schiff (PAS), and scored for pathological changesof glomeruli by an independent pathologist. Data represents mean+SD(when available). Glomerular lesion in vehicle treated animals reachedmaximal at week 38 and throughout the treatment period, and over 85% ofglomeruli exhibited severe lesions. In comparison, approximately 54%glomerular lesion in lower dose of Meisoindigo treated group wasobserved at week 38, and week 42. However, this renal damage significantrecovered at week 45, and it was almost back to the baseline level(24%). In the higher dose of the Meisoindigo treated group, the onlymoderate glomerular lesion was observed at week 38 (36% as compared withvehicle control 85%), and this damage recovered faster than that oflower dose group. The significant recovery to the baseline leveloccurred at week 42 (20% at week 42, and 22% at week 45 as compared withvehicle treated group 85%). Treatment of NZB/W f1 mice with twodifferent doses of Natura also showed protective effects of renaldamages from the lupus.

FIG. 10 depicts histopathological changes in kidneys of NZB/W f1 micewith various treatments: Panel A: from normal control mouse, showsnormal histology of kidney; Panel B&C: from vehicle treated mouse, andD: from mouse treated with lower dose of Meisoindigo. Kidney sectionsfrom vehicle treated mice show significant 1) capillary lumenobliteration; 2) inflammatory cell infiltration; 3) tubular dilationwith intra-tubular protein case deposition and, 4) proliferativeglomerulonephritis (Panel B&C). These histopathological changes wereremarked reduced or absent in Natura-treated mice (Panel D).

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

All patents and literature references cited in this specification arehereby incorporated by reference in their entirety.

The present invention is directed to pharmaceutical compositions andmethods of treating lupus. The method preferably includes the step ofadministering to an animal a therapeutically effective amount of atleast one compound selected from the group consisting of: indigo,isoindigo, indirubin or derivatives thereof.

Lupus is a chronic and prototypical systemic autoimmune diseasecharacterized by multisystem microvascular inflammation leading to organdamage as a result of loss of tolerance to self-antigens. Lupus,includes systemic lupus erythematosus, which is the most common andserious form of lupus. Symptoms of lupus can occur in any part of thebody, including the skin, heart, lungs, kidneys, joints and/or nervoussystem.

The therapeutically “effective amount” is the amount necessary to treatthe lupus and/or a symptom of lupus. The effective amount can bedetermined, in accordance with the invention, by administering to aplurality of tested subjects various amounts of the active agent andthen plotting the physiological response (for example an integrated“lupus index” combining several of the therapeutically beneficialeffects) as a function of the amount. The amount above which thetherapeutic beneficial effects begin to decrease (but is still lowerthan the maximum tolerable dose (MTD)) is the “effective amount.” Due tostatistical distribution typically the “effective amount” is not asingle parameter but a range of parameters.

The terms “treating” or “treatment” in the context of the presentinvention refer to any improvement in the clinical symptoms of thelupus, as well as any improvement in the well-being of the patients, inparticular an improvement manifested by at least one of the following:decreased joint pain, swelling and redness, low grade fever, skinrashes, vasculitis, fatigue, loss of appetite, nausea, and weight loss,chest pain, bruising, menstrual irregularities, sleep disorders, such asrestless legs syndrome and sleep apnea, dryness of the eyes and mouth,brittle hair or hair loss, increase in the remission period betweenacute disease attacks; decrease in the time length of the acute attack;prevention of the onset of severe disease, etc. The treatment may alsoinclude: improvement in renal functions (decrease in blood urea,creatinine, or proteinuria). It should be understood that the presentmethods include, but are not limited to, treating lupus by preventinginflammation associated with the disease. In one embodiment, this isaccomplished by administering an amount sufficient to regulate thecytokines and Th1, Th17, and Treg cell functions involved in thepathological progress of the lupus.

In a preferable embodiment, the invention is directed to the treatmentof an animal diagnosed as having lupus or susceptible thereto.Preferably, the animal is a mammal (e.g., a horse, cow, dog, cat, sheep,etc.) and more preferably, the animal is a human. For administration tonon-human animals in particular, the composition containing thetherapeutic compound may be added to the animal's feed or drinkingwater. In addition, it will be convenient to formulate animal feed anddrinking water products so that the animal takes in an appropriatequantity of the compound in its diet. It will further be convenient topresent the compound in a composition as a premix for addition to thefeed or drinking water. The composition can also added as a food ordrink supplement for humans.

It should be understood that the present method includes, but is notlimited to, treating lupus by reducing inflammation associated with thedisease through modulation of cytokines involved in the pathologicalprogress. When the method is directed to an animal susceptible to lupus,the method includes, but is not limited to, inhibiting the onset of thedisease. Accordingly, in yet another preferred embodiment, the compoundbeing administered is in an amount sufficient to treat lupus byinhibiting pro-inflammatory cytokine expression and/or by stimulatinganti-inflammatory cytokines, but less than sufficient to substantiallyinhibit cyclin dependent kinases (CDKs).

As used herein, “to substantially inhibit CDKs” means a concentrationsufficient to inhibit 30%, more preferably 40% or 45%, and mostpreferably a concentration equal to or higher than the inhibitoryconcentration 50% (IC₅₀) for CDKs. The CDK that is inhibited ispreferably one or more CDK selected from the group consisting of CDK1,CDK2, CDK4 CDK5, and CDK6.

Preferably, the compound is administered in an amount sufficient toinhibit pro-inflammatory cytokine expression and/or to stimulateanti-inflammatory cytokine expression. In one embodiment, the compoundis preferably administered in an amount sufficient to inhibit at one ormore of the pro-inflammatory cytokines selected from the groupconsisting of: IL-1α, β, IL-2, IL-3, IL-6, IL-7, IL-9, IL-12, IL-17,IL-18, TNF-α, LT, LIF, Oncostatin, and IFNc1α, β, γ by at least 10% andmore preferably 30%. In another embodiment, the compound is preferablyin an amount to stimulate anti-inflammatory cytokine expression. In thisembodiment, the compound is preferably administered in an amountsufficient to increase the anti-inflammatory cytokine selected from thegroup consisting of: cytokine IL-4, IL-10, IL-11, W-13 or TGFβ by atleast 25%, more preferably at least 50%, and most preferably at least75%. In a most preferable embodiment, the compound is administered in anamount sufficient to modulate cytokines TNF-α, IL-1β, IL-6, IL17, andIL-10.

The compound is preferably administered in an amount sufficient toreduce proteinuria concentration by at least 30%. Accordingly, themethod may also be used in the treatment of nephritis. Preferably, thenephritis is glomerulonephritis.

In one non-limiting embodiment, the compound is administered in anamount sufficient to modulate a humoral response in the animal beingtreated, preferably resulting in a decrease in total IgG antibodieswithin the animal. Preferably, total IgG antibodies are decreased by atleast 10%, and more preferably by at least 30%.

It should also be noted that therapeutic benefits are typically realizedby the administration of at least 1, 2, 3 or more of the compoundsconcurrently or sequentially. The compounds of the invention may also becombined with other therapies to provide combined therapeuticallyeffective amounts. The compound can be administered, for example, incombination or in conjunction with additional agents, preferablyanti-inflammatory agents, or corticosteroid, or immunosuppressant, suchas methotrixate; or 4) a biologic disease modifying drug, such asbelimumab (Benlysta®). For example, in one embodiment theanti-inflammatory agent is administered separately by injection and thecompound of the invention is concurrently or sequentially administeredorally and/or topically.

Chemical Structures:

The present invention is directed to a specific group of compounds thatinclude isoindigo, indigo, indirubin and derivatives thereof.Preferably, the compounds are Meisoindigo, tri-acetylatedglyco-Meisoindigo (pro-drug) and NATURA, shown as Formulas (IV), (V),and (VI) respectively.

The examples given below are simply to demonstrate different embodimentsof the invention and are not intended in any way to limit the scope ofthe present invention thereto.

Compositions and Dosage Forms:

In a preferred embodiment, the compound is incorporated in apharmaceutical composition that includes a pharmaceutically acceptablecarrier. Advantageously, the composition may further include one or moreanti-lupus agents. The anti-lupus agent can be any agent useful intreating lupus. Preferably the anti-lupus agent can be ananti-inflammatory agent, a corticosteroid, an immunosuppressant or abiologic antibody drug. In an alternative embodiment, theanti-inflammatory arthritis agent is separate. Examples of preferredanti-inflammatory agent include acetaminophen, aspirin, codeine,propoxyphene, fentanyl, palladone, morphine, morphine sulfate,oxycontin, aspirin, pentazocine, tramadol, hydrocodon, naproxen,indomethacin, ibuprofen, fenoprofen, ketorolac tromethamine, cholinemagnesium trisalicylate, rofecoxib, and combinations thereof.

Examples of preferred COX-2 inhibitors include rofecoxib, parecoxib,etoricoxib, and celecoxib.

Examples of preferred corticosteroids include betamethasone, cortisone,dexamethasone, hydrocortisone, methylprednisolone, prednisolone,prednisone, triamcinolone, and combinations thereof.

Examples of preferred NSAIDs include salicylate, arylalkanoic acid,2-arylpropionic acid, N-arylanthranilic acid, oxiam, coxib, andsulphonanilide.

Examples of preferred immunosuppressants and biologics includehydroxychloroquine, chloroquine, leflunomide, methotrexate,sulfasalazine, gold, gold thiomalate, aurothioglucose, auranofin,azathioprine, cyclophosphamide, anti-tumor necrosis factor (anti-TNF,e.g., etanercept, infliximab, and adalimumab), anti-IL-1, Anti-CD20,anakinra, belimumab (Benlysta®), or combinations thereof.

In another preferred embodiment, pharmaceutical composition comprisesMeisoindigo (NATURA-α) and/or NATURA. Typically the pharmaceuticallyacceptable carrier is an inert diluent.

The pharmaceutical compositions of the invention can take a variety offorms adapted to the chosen route of administration as discussed above.Those skilled in the art will recognize various synthetic methodologiesthat may be employed to prepare non-toxic pharmaceutically acceptablecompositions of the compounds described herein. Those skilled in the artwill also recognize a wide variety of non-toxic pharmaceuticallyacceptable solvents that may be used to prepare solvates of thecompounds of the invention, such as water, ethanol, mineral oil,vegetable oil, and dimethylsulfoxide.

Pharmaceutical compositions can be used in the preparation of individualdosage forms. Consequently, pharmaceutical compositions and dosage formsof the invention comprise the active ingredients disclosed herein. Thenotation of “the compound” signifies the compounds of the inventiondescribed herein or salts thereof. Pharmaceutical compositions anddosage forms of the invention can further comprise a pharmaceuticallyacceptable carrier.

The term “pharmaceutically acceptable” means approved by a regulatoryagency of the Federal or a state government or listed in the U.S.Pharmacopeia or other generally recognized pharmacopeia for use inanimals, and more particularly in humans. The term “carrier” refers to adiluent, adjuvant, excipient, or vehicle with which an active ingredientis administered. Such pharmaceutical carriers can be liquids, such aswater and oils, including those of petroleum, animal, vegetable orsynthetic origin, such as peanut oil, soybean oil, mineral oil, sesameoil and the like. The pharmaceutical carriers can be saline, gum acacia,gelatin, starch paste, talc, keratin, colloidal silica, urea, and thelike. In addition, other excipients can be used.

Single unit dosage forms of the invention are suitable for oral, mucosal(e.g., nasal, sublingual, vaginal, buccal, or rectal), parenteral (e.g.,subcutaneous, intravenous, bolus injection, intramuscular, orintraarterial), or transdermal administration to a patient. Examples ofdosage forms include, but are not limited to: tablets; caplets;capsules, such as soft elastic gelatin capsules; cachets; troches;lozenges; dispersions; suppositories; ointments; cataplasms (poultices);pastes; powders; dressings; creams; plasters; solutions; patches;aerosols (e.g., nasal sprays or inhalers); gels; liquid dosage formssuitable for oral, topical, or mucosal administration to a patient,including suspensions (e.g., aqueous or non-aqueous liquid suspensions,oil-in-water emulsions, or a water-in-oil liquid emulsions); solutions,and elixirs; liquid dosage forms suitable for parenteral administrationto a patient; and sterile solids (e.g., crystalline or amorphous solids)that can be reconstituted to provide liquid dosage forms suitable forparenteral administration to a patient.

The composition, shape, and type of dosage forms of the invention willtypically vary depending on their route of administration and animalbeing treated. For example, a parenteral dosage form may contain smalleramounts of one or more of the active ingredients it comprises than anoral dosage form used to treat the same disease. These and other ways inwhich specific dosage forms encompassed by this invention will vary fromone another will be readily apparent to those skilled in the art. See,e.g., Remington's Pharmaceutical Sciences, 18th ed., Mack Publishing,Easton Pa. (1990).

Typical pharmaceutical compositions and dosage forms comprise one ormore excipients. Suitable excipients are well known to those skilled inthe art of pharmacy, and non-limiting examples of suitable excipientsare provided herein. Whether a particular excipient is suitable forincorporation into a pharmaceutical composition or dosage form dependson a variety of factors well known in the art including, but not limitedto, the way in which the dosage form will be administered to a patient.For example, oral dosage forms such as tablets may contain excipientsnot suited for use in parenteral dosage forms. The suitability of aparticular excipient may also depend on the specific active ingredientsin the dosage form. For example, the decomposition of some activeingredients may be accelerated by some excipients such as lactose, orwhen exposed to water.

The invention further encompasses pharmaceutical compositions and dosageforms that comprise one or more compounds that reduce the rate by whichan active ingredient will decompose. Such compounds, which are referredto herein as “stabilizers” include, but are not limited to, antioxidantssuch as ascorbic acid, pH buffers, or salt buffers.

Furthermore, in yet another embodiment the compound—isoindigo, indigo,indirubin, or a derivative thereof—is in an amount sufficient to treatthe inflammatory-related disease by inhibiting pro-inflammatory cytokineexpression and/or by stimulating anti-inflammatory cytokine expression,but less than sufficient to substantially inhibit cyclin dependentkinases. In this embodiment, the additional anti-inflammatory agentmentioned above is not required in the composition to be effective, butis advantageous.

In one preferred embodiment, the dosage amount of the activate is lessthan sufficient to inhibit 50%, 40%, 30%, or 20% of cyclin dependentkinases selected from the group consisting of: CDK2, CDK4, and CDK6.Cell cycle progression and cell division are driven by the sequentialactivation of a group of CDKs (e.g., CDK2, CDK4, and CDK6). Despite thissequential activation, a high level of functional redundancy existsamong these CDKs. As a result, the Mitotic Index (MI) was developed as astandard measure of the proliferation status of a cell population. It isdefined as the ratio between the number of cells in mitosis and thetotal number of cells. This index is used to study the activity of CDKinhibitors and/or cell proliferation [6-7]. The mitotic index can bemeasured under light microscopy from a slide. To calculate the MI, onedivides the number of cells containing visible chromosomes by the totalnumber of cells in the field of view. Another important biomarker widelyused to measure cell proliferation is ki67 [6, 8]. The ki-67 protein ispresent during all active phases of the cell cycle but is absent fromresting cells, making it an excellent marker for determining the growthfraction of a given cell population. Thus, cells in the cell cycle canbe identified using antibodies against the nuclear antigen ki-67, which,as explained above, is strictly associated with cell proliferationInhibition of proliferation can therefore be directly correlated to CDKinhibition by one skilled in the art.

For a particular condition or method of treatment, the dosage isdetermined empirically, using known methods, and will depend upon factssuch as the biological activity of the particular compound employed, themeans of administrations, the age, health and body weight of the host;the nature and extent of the symptoms; the frequency of treatment; theadministration of other therapies and the effect desired.

The dosage is generally from 0.036 μmol/kg/day to 543.4 μmol/kg/day(i.e. in case of Meisoindigo, the dose range is 0.01 mg/kg/day to 150mg/kg/day) and more preferably 18.1 μmol/kg/day to 362.3 μmol/kg/day(i.e. in case of Meisoindigo, the dose is 5-100 mg/kg/day). In oneparticular embodiment, the animal is a human and the amount is from 18.1μmol/day to 362.3 μmol/day (i.e. when use Meisoindigo, the dose is 5-100mg/day). Dosage unit forms will generally contain between from about 1mg to about 100 mg of the compound.

For illustrative purposes, dosage levels of the administered activeingredients in animals may be: intravenous, 0.036 to 7.24 μmol/kg (i.e.if Meisoindigo is used, the dose will be equal to 0.01 to about 2mg/kg); intramuscular, 0.181 to 18.12 μmol/kg (i.e. if Meisoindigo isused, the dose will be equal to 0.05 to about 5 mg/kg); orally, 0.181μmol/kg to 362.3 μmol/kg (i.e. if Meisoindigo is used, the dose will beequal to 0.05 to about 100 mg/kg); intranasal instillation, 1.812μmol/kg to 36.23 μmol/kg (i.e. if Meisoindigo is used, the dose will beequal to 0.5 to about 10 mg/kg); and aerosol, 1.81 μmol/kg to 362.3μmol/kg (i.e. if Meisoindigo is used, the dose will be equal to 0.5 toabout 100 mg/kg of host body weight). The dose level is usually about 10times less in human than other animals. The various possible dosages andmethods of administration are given as illustrative examples only. Theactual dosages and method of administration or delivery may bedetermined by one of skill in the art.

Frequency of dosage may also vary depending on the compound used andwhether an extended release formulation is used. For treatment of mostdisorders, however, a dosage regimen of three times daily or less ispreferred. In a preferred embodiment, the treatment scheme is twice aday or less.

Preferably the compound is administered to the animal for a period of atleast one week, more preferably for at least 3 months, and even morepreferably for at least 6 months. Applicants have discovered benefits ofcontinuous extended administration of the compound to the animal beingtreated. In certain embodiments, administration may be for at least 9month, at least a year or even longer. For certain lupus conditions, thetreatment may require continuous administration during the life of theanimal being treated.

Expressed in terms of concentration, a compound may be present in thecompositions of the present invention for localized use about the cutis,intranasally, pharyngolaryngeally, bronchially, intravaginally,rectally, or ocularly in concentration of from about 0.01 to about 30%w/w of the composition; preferably about 1 to about 20% w/w of thecomposition; and for parenteral use in a concentration of from about0.05 to about 10% w/v of the composition and preferably from about 0.1to about 10% w/v.

Preferred compounds of the invention to be used in the compositions willhave desirable pharmacological properties that include, but are notlimited to, oral bioavailability, low toxicity, low serum proteinbinding and desirable in vitro and in vivo half-lives. Assays may beused to predict these desirable pharmacological properties. Assays usedto predict bioavailability include transport across human intestinalcell monolayers, including Caco-2 cell monolayers. Toxicity to culturedhepatocyctes may be used to predict compound toxicity.

Oral Dosage Forms

Pharmaceutical compositions of the invention that are suitable for oraladministration can be presented as discrete dosage forms, such as, butare not limited to, tablets (e.g., chewable tablets), caplets, capsules,and liquids (e.g., flavored syrups). Such dosage forms containpredetermined amounts of active ingredients, and may be prepared bymethods of pharmacy well known to those skilled in the art. Seegenerally, Remington's Pharmaceutical Sciences, 18th ed., MackPublishing, Easton Pa. (1990).

Typical oral dosage forms of the invention are prepared by combining theactive ingredients in an intimate admixture with at least one excipientaccording to conventional pharmaceutical compounding techniques.Excipients can take a wide variety of forms depending on the form ofpreparation desired for administration. For example, excipients suitablefor use in oral liquid or aerosol dosage forms include, but are notlimited to, water, glycols, oils, alcohols, flavoring agents,preservatives, and coloring agents. Examples of excipients suitable foruse in solid oral dosage forms (e.g., powders, tablets, capsules, andcaplets) include, but are not limited to, starches, sugars,micro-crystalline cellulose, diluents, granulating agents, lubricants,binders, and disintegrating agents.

Because of their ease of administration, tablets and capsules representthe most advantageous oral dosage unit forms, in which case solidexcipients are employed. If desired, tablets can be coated by standardaqueous or non-aqueous techniques. Such dosage forms can be prepared byany of the methods of pharmacy. In general, pharmaceutical compositionsand dosage forms are prepared by uniformly and intimately admixing theactive ingredients with liquid carriers, finely divided solid carriers,or both, and then shaping the product into the desired presentation ifnecessary.

For example, a tablet can be prepared by compression or molding.Compressed tablets can be prepared by compressing in a suitable machinethe active ingredients in a free-flowing form such as powder orgranules, optionally mixed with an excipient. Molded tablets can be madeby molding in a suitable machine a mixture of the powdered compoundmoistened with an inert liquid diluent.

Examples of excipients that can be used in oral dosage forms of theinvention include, but are not limited to, binders, fillers,disintegrants, and lubricants. Binders suitable for use inpharmaceutical compositions and dosage forms include, but are notlimited to, corn starch, potato starch, or other starches, gelatin,Natural and synthetic gums such as acacia, sodium alginate, alginicacid, other alginates, powdered tragacanth, guar gum, cellulose and itsderivatives (e.g., ethyl cellulose, cellulose acetate, carboxymethylcellulose calcium, sodium carboxymethyl cellulose), polyvinylpyrrolidone, methyl cellulose, pre-gelatinized starch, hydroxypropylmethyl cellulose, (e.g., Nos. 2208, 2906, 2910), microcrystallinecellulose, and mixtures thereof.

Suitable forms of microcrystalline cellulose include, but are notlimited to, the materials sold as AVICEL-PH-101, AVICEL-PH-103 AVICELRC-581, AVICEL-PH-105 (available from FMC Corporation, American ViscoseDivision, Avicel Sales, Marcus Hook, Pa.), and mixtures thereof. Anspecific binder is a mixture of microcrystalline cellulose and sodiumcarboxymethyl cellulose sold as AVICEL RC-581. Suitable anhydrous or lowmoisture excipients or additives include AVICEL-PH-103™ and Starch 1500LM.

Examples of fillers suitable for use in the pharmaceutical compositionsand dosage forms disclosed herein include, but are not limited to, talc,calcium carbonate (e.g., granules or powder), microcrystallinecellulose, powdered cellulose, dextrates, kaolin, mannitol, silicicacid, sorbitol, starch, pre-gelatinized starch, and mixtures thereof.The binder or filler in pharmaceutical compositions of the invention istypically present in from about 50 to about 99 weight percent of thepharmaceutical composition or dosage form.

Disintegrants are used in the compositions of the invention to providetablets that disintegrate when exposed to an aqueous environment.Tablets that contain too much disintegrant may disintegrate in storage,while those that contain too little may not disintegrate at a desiredrate or under the desired conditions. Thus, a sufficient amount ofdisintegrant that is neither too much nor too little to detrimentallyalter the release of the active ingredients should be used to form solidoral dosage forms of the invention. The amount of disintegrant usedvaries based upon the type of formulation, and is readily discernible tothose of ordinary skill in the art. Typical pharmaceutical compositionscomprise from about 0.5 to about 15 weight percent of disintegrant,preferably from about 1 to about 5 weight percent of disintegrant.

Disintegrants that can be used in pharmaceutical compositions and dosageforms of the invention include, but are not limited to, agar-agar,alginic acid, calcium carbonate, microcrystalline cellulose,croscarmellose sodium, crospovidone, polacrilin potassium, sodium starchglycolate, potato or tapioca starch, other starches, pre-gelatinizedstarch, other starches, clays, other algins, other celluloses, gums, andmixtures thereof.

Lubricants that can be used in pharmaceutical compositions and dosageforms of the invention include, but are not limited to, calciumstearate, magnesium stearate, mineral oil, light mineral oil, glycerin,sorbitol, mannitol, polyethylene glycol, other glycols, stearic acid,sodium lauryl sulfate, talc, hydrogenated vegetable oil (e.g., peanutoil, cottonseed oil, sunflower oil, sesame oil, olive oil, corn oil, andsoybean oil), zinc stearate, ethyl oleate, ethyl laureate, agar, andmixtures thereof. Additional lubricants include, for example, a syloidsilica gel (AEROSIL 200, manufactured by W.R. Grace Co. of Baltimore,Md.), a coagulated aerosol of synthetic silica (marketed by Degussa Co.of Plano, Tex.), CAB-O-SIL (a pyrogenic silicon dioxide product sold byCabot Co. of Boston, Mass.), and mixtures thereof. If used at all,lubricants are typically used in an amount of less than about 1 weightpercent of the pharmaceutical compositions or dosage forms into whichthey are incorporated.

A preferred solid oral dosage form of the invention comprises an activeingredient, anhydrous lactose, microcrystalline cellulose,polyvinylpyrrolidone, stearic acid, colloidal anhydrous silica, andgelatin.

Delayed Release Dosage Forms

Active ingredients of the invention can be administered by controlledrelease means or by delivery devices that are well known to those ofordinary skill in the art. Examples include, but are not limited to,those described in U.S. Pat. Nos. 3,845,770; 3,916,899; 3,536,809;3,598,123; and 4,008,719, 5,674,533, 5,059,595, 5,591,767, 5,120,548,5,073,543, 5,639,476, 5,354,556, and 5,733,566, each of which isincorporated herein by reference. Such dosage forms can be used toprovide slow or controlled-release of one or more active ingredientsusing, for example, hydropropylmethyl cellulose, other polymer matrices,gels, permeable membranes, osmotic systems, multilayer coatings,microparticles, liposomes, microspheres, or a combination thereof toprovide the desired release profile in varying proportions. Suitablecontrolled-release formulations known to those of ordinary skill in theart, including those described herein, can be readily selected for usewith the active ingredients of the invention. The invention thusencompasses single unit dosage forms suitable for oral administrationsuch as, but not limited to, tablets, capsules, gelcaps, and capletsthat are adapted for controlled-release.

All controlled-release pharmaceutical products have a common goal ofimproving drug therapy over that achieved by their non-controlledcounterparts. Ideally, the use of an optimally designedcontrolled-release preparation in medical treatment is characterized bya minimum of drug substance being employed to cure or control thecondition in a minimum amount of time. Advantages of controlled-releaseformulations include extended activity of the drug, reduced dosagefrequency, and increased patient compliance. In addition,controlled-release formulations can be used to affect the time of onsetof action or other characteristics, such as blood levels of the drug,and can thus affect the occurrence of side (e.g., adverse) effects.

Most controlled-release formulations are designed to initially releasean amount of drug (active ingredient) that promptly produces the desiredtherapeutic effect, and gradually and continually release of otheramounts of drug to maintain this level of therapeutic or prophylacticeffect over an extended period of time. In order to maintain thisconstant level of drug in the body, the drug must be released from thedosage form at a rate that will replace the amount of drug beingmetabolized and excreted from the body. Controlled-release of an activeingredient can be stimulated by various conditions including, but notlimited to, pH, temperature, enzymes, water, or other physiologicalconditions or compounds.

Parenteral Dosage Forms

Parenteral dosage forms can be administered to patients by variousroutes including, but not limited to, subcutaneous, intravenous, bolusinjection, intramuscular, and intra-arterial. Because theiradministration typically bypasses patients' natural defenses againstcontaminants, parenteral dosage forms are preferably sterile or capableof being sterilized prior to administration to a patient. Examples ofparenteral dosage forms include, but are not limited to, solutions readyfor injection, dry products ready to be dissolved or suspended in apharmaceutically acceptable vehicle for injection, suspensions ready forinjection, and emulsions.

Suitable vehicles that can be used to provide parenteral dosage forms ofthe invention are well known to those skilled in the art. Examplesinclude, but are not limited to: Water for Injection USP; aqueousvehicles such as, but not limited to, Sodium Chloride Injection,Ringer's Injection, Dextrose Injection, Dextrose and Sodium ChlorideInjection, and Lactated Ringer's Injection; water-miscible vehicles suchas, but not limited to, ethyl alcohol, polyethylene glycol, andpolypropylene glycol; and non-aqueous vehicles such as, but not limitedto, corn oil, cottonseed oil, peanut oil, sesame oil, ethyl oleate,isopropyl myristate, and benzyl benzoate.

Compounds that increase the solubility of one or more of the activeingredients disclosed herein can also be incorporated into theparenteral dosage forms of the invention.

Transdermal, Topical, and Mucosal Dosage Forms

Transdermal, topical, and mucosal dosage forms of the invention include,but are not limited to, ophthalmic solutions, sprays, aerosols, creams,lotions, ointments, gels, solutions, emulsions, suspensions, or otherforms known to one of skill in the art. See, e.g., Remington'sPharmaceutical Sciences, 16th and 18th eds., Mack Publishing, Easton Pa.(1980 & 1990); and Introduction to Pharmaceutical Dosage Forms, 4th ed.,Lea & Febiger, Philadelphia (1985). Dosage forms suitable for treatingmucosal tissues within the oral cavity can be formulated as mouthwashesor as oral gels. Further, transdermal dosage forms include “reservoirtype” or “matrix type” patches, which can be applied to the skin andworn for a specific period of time to permit the penetration of adesired amount of active ingredients.

Suitable excipients (e.g., carriers and diluents) and other materialsthat can be used to provide transdermal, topical, and mucosal dosageforms encompassed by this invention are well known to those skilled inthe pharmaceutical arts, and depend on the particular tissue to which agiven pharmaceutical composition or dosage form will be applied. Withthat fact in mind, typical excipients include, but are not limited to,water, acetone, ethanol, ethylene glycol, propylene glycol,butane-1,3-diol, isopropyl myristate, isopropyl palmitate, mineral oil,and mixtures thereof to form lotions, tinctures, creams, emulsions, gelsor ointments, which are non-toxic and pharmaceutically acceptable.Moisturizers or humectants can also be added to pharmaceuticalcompositions and dosage forms if desired. Examples of such additionalingredients are well known in the art. See, e.g., Remington'sPharmaceutical Sciences, 16th and 18th eds., Mack Publishing, Easton Pa.(1980 & 1990).

Depending on the specific tissue to be treated, additional componentsmay be used prior to, in conjunction with, or subsequent to treatmentwith active ingredients of the invention. For example, penetrationenhancers can be used to assist in delivering the active ingredients tothe tissue. Suitable penetration enhancers include, but are not limitedto: acetone; various alcohols such as ethanol, oleyl, andtetrahydrofuryl; alkyl sulfoxides such as dimethyl sulfoxide; dimethylacetamide; dimethyl formamide; polyethylene glycol; pyrrolidones such aspolyvinylpyrrolidone; Kollidon grades (Povidone, Polyvidone); urea; andvarious water-soluble or insoluble sugar esters such as Tween 80(polysorbate 80) and Span 60 (sorbitan monostearate).

The pH of a pharmaceutical composition or dosage form, or of the tissueto which the pharmaceutical composition or dosage form is applied, mayalso be adjusted to improve delivery of one or more active ingredients.Similarly, the polarity of a solvent carrier, its ionic strength, ortonicity can be adjusted to improve delivery. Compounds such asstearates can also be added to pharmaceutical compositions or dosageforms to advantageously alter the hydrophilicity or lipophilicity of oneor more active ingredients so as to improve delivery. In this regard,stearates can serve as a lipid vehicle for the formulation, as anemulsifying agent or surfactant, and as a delivery-enhancing orpenetration-enhancing agent. Different salts of the active ingredientscan be used to further adjust the properties of the resultingcomposition.

It is to be understood that the foregoing describes preferredembodiments of the present invention and that modifications may be madetherein without departing from the spirit or scope of the presentinvention as set forth in the claims.

The present invention will now be illustrated by the followingnon-limiting examples. It is to be understood that the foregoingdescribes preferred embodiments of the present invention and thatmodifications may be made therein without departing from the spirit orscope of the present invention as set forth in the claims.

EXAMPLES Example 1: Meisoindigo Reduces the Secretion of IL-β in HumanMonocytic Cell Line THP-1 Cells

Materials and Methods

Materials:

Meisoindigo and NATURA were synthesized by Natrogen Therapeutics, Inc,purified by high performance liquid chromatography (HPLC) with a purityof 98.5%, and their structures confirmed by mass spectrometry andnuclear magnetic resonance (NMR). Meisoindigo is a dark-reddish crystal,with a molecular weight of 376. It was prepared in a solution ofdimethyl sulfoxide (DMSO), and stored under −20° C. for the experimentsin vitro. Human monocytic cell line, THP-1 (90), was purchased fromATCC. The cells were maintained according to the supplier'sinstructions. Approximately 1×10⁵ cells/ml were cultured at 37° C., 5%CO₂ for 24 hours in Modified RPMI-1640 Medium (Invitrogen) supplementedwith 10% FBS.

Methods:

The cells were stimulated with or without 1 μM of lipopolysaccharide(LPS, Sigma), and exposed for 24 hours to different concentrations ofMeisoindigo (from 31.25 nM to 16,000 nM). Viability of cells wasexamined under microscope after trypan blue staining. Protein levels ofIL-1β secreted into the culture media by the cells were then measured byELISA and calculated from its standard curve using an assay Kit from R&DSystems according to instructions provided by the supplier. The methodwas established and validated by a good standard curve obtained. Anexample of the standard curve is shown in FIG. 2, panel A.

Statistical Analysis:

All data were expressed as a mean±SD. Statistical significance of anydifference between the control (LPS) and experimental groups wasdetermined by the Student's t-test. P values between the 2 groups mustbe at least smaller than 0.05 to be considered statisticallysignificant.

Results and Discussion

IL-1β is a pleiotropic pro-inflammatory cytokine involved in thepathological process of various inflammatory-related diseases. Toelucidate the activity of Meisoindigo, a representational small moleculeof derivatives of indigo, isoindigo and indirubin, against inflammation,we examined the activity of Meisoindigo on the secretion of IL-1β inhuman monocytic THP-1 cells. As shown in FIG. 2, panel B, the basallevel of IL-1β in human monocytic THP-1 cells was found to beundetectable. It has been demonstrated previously that increases ofprotein IL-1β and mRNA levels in response to lipopolysaccharide (LPS),predominantly are a result of increased transcription of the gene[9-10]. In this invention, we also observed that upon stimulation ofLPS, the THP-1 cells secreted a large amount of IL-1β into the medium(92.38±3.667 pg/ml, FIG. 2, panel B). Interestingly, the stimulatedsecretion of IL-β was significantly inhibited by simultaneously exposingthe cells to Meisoindigo. Most importantly, we found that Meisoindigowas a potent, but also moderate IL-1β inhibitor.

This characteristic will be an advantage to patients for high efficacywith lesser side effects when it is used for the treatment ofinflammatory disorders. Potent, because over 50% reduction of the LPSmediated IL-1β secretion was repeatedly achieved when the cells wereexposed to Meisoindigo at concentrations as low as 31.25 nM; moderate,because increasing the concentration of Meisoindigo up to 8 μM did notresult in further reduction of the secretion, indicating that theactivity reached was maximal. This is different from the effect ofMeisoindigo or NATURA on the inhibition of cyclin-dependent kinases(CDKs) in which a much higher concentration is needed for the 50%inhibition of CDK activity (approximately 1.6 μM) in LNCaP prostatecancer cells as demonstrated in our previous patent.

The last point is significant since the prior art EP 1 079 826 only setout to inhibit CDKs, rather than cytokines. As a result, much lowerconcentrations of medicaments are employed in the present invention ascompared to the prior art. Furthermore, particular derivatives may alsobe more suitable for cytokine inhibition as compared to CDK inhibition.

Example 2: Meisoindigo Inhibits the Secretion and Expression of IL-6 inHuman Monocytic Cell Line THP-1 Cells

Materials and Methods

Materials:

The representative derivative Meisoindigo was used. The cell line andthe procedure of ELISA were the same as described in Example 1. StandardIL-6 protein was used to establish a standard curve for the calculationof IL-6 in the medium secreted by the cells (LPS-stimulated ornon-stimulated cells in the presence or absence of Meisoindigo). Atypical standard curve is shown in FIG. 3, panel A. Statistical analysisalso followed the method described in Example 1.

Methods:

Real Time PCR:

The effect of Meisoindigo on the transcription of IL-6 (RNA levels) wasdetermined by a technique of real time polymerase chain reaction (realtime PCR). Total RNA was extracted using a Qiagen Rneasy minit kit, andthe HPRT gene was used as internal control.

Human monocytic THP-1 cells at exponential growth phase were exposed to1 μg/ml of LPS, 1 μM of Meisoindigo, or 1 μg/ml of LPS plus 1 μM ofMeisoindigo for 24 hours. The cells were then harvested, washed andtotal RNA extracted for real time PCR assay. Total RNA (300 ng) wastreated with DNase I (Promega, Madison, Wis.), and SuperScript II(Invitrogen, Carlsbad, Calif.) and oligo(dT) were used for reversetranscription according to the manufacturers' instructions. Real-timePCR reactions were performed in a 25-μL volume containing diluted cDNA,Sybr Green PCR Master Mix (Applied Biosystems), and 2.5 μM each IL-6gene-specific primer: R: 5′-TCAATTCGTTCTGAAGAGG (SEQ ID NO. 1) and F:5′-CCCCCAGGAGAAGATTCC (SEQ ID NO. 2). An ABI SDS7700 analyzer (AppliedBiosystems) was used at 50° C. for 2 minutes and 95° C. for 10 minutes,followed by 40 cycles at 95° C. for 15 seconds and 60° C. for 1 minute.Test cDNA results were normalized to HPRT internal control measured onthe same plate. After cycling, the specificity of amplification wasvalidated by the generation of a melting curve through slow deNaturationof the PCR products and then by gel electrophoresis.

Results and Discussion

IL-6 is another key pro-inflammatory cytokine involved in inflammation.Therefore, the effect of Meisoindigo on the secretion/expression wasexamined. Similar to IL-1β, the basal level of IL-6 was undetectable inhuman monocytic THP-1 Cells. Upon stimulation with 1 μg/ml LPS, thecells moderately secreted IL-6 into the media (33.64±3.29 pg/ml).Meisoindigo was found to strongly inhibit the secretion of IL-6 in theLPS stimulated THP-1 cells. Approximately 85% of the reduction ofsecretion was observed when the stimulated cells were exposed toMeisoindigo at the lowest concentration of 31.25 nM of the experiment(P<0.001) (FIG. 3, panel B).

To explore whether the reduction of IL-6 secretion mediated byMeisoindigo was due to its inhibition on the LPS stimulated expressionof IL-6, a real time PCR was applied to measure the effect ofMeisoindigo on the IL-6 mRNA transcription. As shown in FIG. 3, panel C,a significant induction of IL-6 transcription was observed when theTHP-1 cells were exposed to 1 μg/ml LPS, which is consistent with theprevious reports (93). Interestingly, the LPS-induced IL-6 transcriptioncould be completely suppressed by exposing the LPS-stimulated THP-1cells to 1 μM of Meisoindigo (P<0.001). This finding thus indicates thatthe inhibition of Meisoindigo on LPS-stimulated secretion of IL-6probably results from the suppression of the agent on LPS-mediated IL-6production in THP-1 cells.

Stimulation of LPS on human monocytes activates IL-6 transcriptionalsignaling pathways. LPS can bind to a protein termed a LPS bindingprotein (LBP). It has been shown that after its transfer by LBP to theCD14 receptor, LPS interacted with the signaling receptor TLR4 and theaccessory protein MD-2. This interaction resulted in the activation ofNF-κB and 3 MAP kinases, thus increasing IL-6 transcription [11-12].Whether suppression of Meisoindigo on LPS-mediated IL-6 transcription isdue to the interruption of the signal transduction pathways needs to befurther investigated.

Example 3: Meisoindigo Suppresses the Secretion of TNF-α in HumanMonocytic THP-1 Cells

Materials and Methods

The representative derivative Meisoindigo was used. The cell line andthe procedure of ELISA to measure secretion of TNF-α were the same asdescribed in Example 1, except the standard TNF-α protein was used toestablish a standard curve for the calculation of the protein secretedin the medium by the cells (LPS-stimulated or non-stimulated cells inthe presence or absence of Meisoindigo). A typical standard curve isshown in FIG. 4, panel A.

The effect of Meisoindigo on the transcription of TNF-α (RNA levels) wasdetermined by a technique of real time PCR using the same proceduresdescribed in Example 2, except the specific primers for TNF-α were usedas follows: 5′-TGCCCAG-ACTCGGCAAAG (SEQ ID NO. 3), and5′GGAGAAGGGTGACCGACT (SEQ ID NO. 4). Total RNA was extracted using aQiagen Rneasy minit kit, and the HPRT gene was used as internal control.

Human monocytic THP-1 cells grown exponentially were exposed to 0.1μg/ml of LPS, 4 μM of Meisoindigo, or 1 μg/ml of LPS plus 4 μM ofMeisoindigo for 24 hours. The cells were then harvested, washed andtotal RNA extracted for real time PCR assay as described in Example 2.

Results and Discussion

TNF-α is a crucial pro-inflammatory cytokine investigated extensivelyduring the past decade due to its important biological functions againstcancer and its pathological role in the inflammatory disorders. Severalinhibitors of TNF-α have been marketed for the treatment of variousinflammatory-related diseases. As a potential anti-inflammatory agent,we explored a role of Meisoindigo in the regulation of TNF-α in thisinvention.

As an established model system, stimulation of THP-1 cells with LPSresulted in a huge secretion of TNF-α (FIG. 4, panel B). However,Meisoindigo effectively inhibited the secretion of TNF-α in theLPS-stimulated THP-1 cells in a concentration-dependent manner (FIG. 4,panel B). Approximately 50% reduction of the secretion was achieved whenstimulated cells were exposed to 2.0 μM of Meisoindigo for 24 hours(P<0.001, as compared LPS plus Meisoindigo with LPS alone) at which noapoptotic cells were observed using trypan blue staining. Increasing theconcentration of Meisoindigo up to 8 μM did not cause further reductionof TNF-α secretion while no cell deaths were observed. A completeinhibition was obtained however when the stimulated cells were treatedwith 16 μM of Meisoindigo at which approximately only 20% apoptoticcells appeared.

Real time PCR assays showed no effect of Meisoindigo (4 μM) on TNF-αmRNA levels (FIG. 4, panel C), indicating that reduction of TNF-αproduction in LPS-stimulated THP-1 cells by Meisoindigo occurs atpost-transcriptional level. It is well established that AU-rich elements(ARE) in the TNF-α mRNA 3′ UTR are involved in mRNA stability andtranslational efficiency [13]. TNF-α ARE is a target of themRNA-stabilizing factor HuR [14]. Maturation of TNF-α mRNA is affectedby a cis-element (2-APRE) in the 3′UTR, which renders splicing of TNF-αprecursor transcripts dependent on activation of RNA-activated proteinkinase (PKR) [15].

Although the mechanisms by which Meisoindigo inhibits the secretion ofTNF-α in LPS-stimulated THP-1 cells need to be established, Meisoindigois a novel small molecule inhibiting TNF-α without cytotoxicities, whichwould make it an ideal medicine for the treatment of variousinflammatory-related diseases.

Example 4: Meisoindigo Stimulates the Secretion of IL-10 in HumanMonocytic THP-1 Cells

Materials and Methods

Meisoindigo and the THP-1 cell line used in this Example were the sameas described in Example 1. The procedures of ELISA to measure thesecretion of IL-10 also followed the procedures described in Example 1,except the standard IL-10 protein was used to establish the standardcurve (FIG. 5, panel A) for the calculation of the protein secreted inthe medium by the cells (LPS-stimulated or non-stimulated cells in thepresence or absence of Meisoindigo).

Results and Discussion

The functioning of the immune system is finely tuned by the activitiesof pro-inflammatory and regulatory mediators or cytokines, andinflammatory-related diseases have been considered a result of imbalancebetween these types of molecules [16-17]. To understand whether theanti-inflammatory effects of small molecules claimed in this inventionare capable of induction of regulatory cytokines, the effect ofMeisoindigo on the secretion of IL-10 was investigated. As shown in FIG.5, panel B, a moderate but significant stimulation of IL-10 secretion inTHP-1 cells was observed. Approximately 60% increase in the IL-10secretion was achieved when the THP-1 cells were treated with 0.0625 μMof Meisoindigo (P<0.05). In contrast, as an inflammatory stimulator, LPSslightly decreased the secretion of cytokine.

Example 5: Meisoindigo and its Derivatives, at Low Concentrations,Select Cytokines, Rather than CDKs as Primary Molecular Targets

Materials and Methods

Materials:

Meisoindigo and NATURA were synthesized by Natrogen Therapeutics, Inc,as described in the above examples.

Human monocytic cell line, THP-1 [18] was purchased from ATCC. The cellswere maintained according to the supplier's instructions. Approximately1×10⁵ cells/ml were cultured at 37° C., 5% CO₂ for 24 hours in ModifiedRPMI-1640 Medium (Invitrogen) supplemented with 10% FBS.

Methods:

-   -   1) Effects of Meisoindigo and NATURA on the expression/secretion        of cytokines IL-1β, IL-6, IL-10: The human monocytic THP-1 cells        grown exponentially were stimulated with or without 1 μM of        lipopolysaccharide (LPS, Sigma), and exposed for 24 hours to        different concentrations of Meisoindigo and NATURA (from 31.25        nM and 62.5 nM), respectively. Viability of cells was examined        by trypan blue exception assay. Protein levels of IL-1β secreted        into the culture media by the cells were then measured by ELISA        and calculated from its standard curve using an assay Kit from        R&D Systems according to instructions provided by the supplier        as described in the examples of 1 to 4.    -   2) Effects of Meisoindigo and/or NATURA on activity of cyclin        dependent kinases (CDK) in THP-1 cells [19]: THP-1 cells grown        exponentially were exposed to 31.25, 62.5, and 1500 nM of        Meisoindigo or NATURA for 24 hr, respectively. The cells were        harvested, washed, and total proteins extracted as described        previously [20]. One hundred μg of the proteins were        immuno-precipitated using antibodies against either cdk2, cdk4/6        or cyclin D1 overnight at 4° C. in the presence of a cocktail of        protease inhibitors. The immuno-precipitates were washed 4 times        with protein extraction buffer and once with kinase assay        buffer, and reacted with 75 μg/ml histone H1 in the presence of        [γ-³²P]-ATP (10 μCi/10 μM). The phosphorylated histone H1        (represent cdk activity) was measured by scintillation counting        or by SDS-polyacrylaimde gel electrophoresis [21-22].    -   3) Statistical Analysis: All data were expressed as a mean±SD.        Statistical significance of any difference between the control        (LPS) and experimental groups was determined by the Student's        t-test. P values between the 2 groups must be at minimum smaller        than 0.05 to be considered statistically significant.        Results and Discussion

Since it has been shown that indirubin and its derivatives inhibitedcyclin dependent kinases, it thus could be an effective treatment ofdiseases associated with the loss of proliferation control via CDKinhibition. To examine which cellular molecules are primary targetsrelated to the anti-inflammatory properties of this class of compounds,we compared how Meisoindigo and NATURA modulated n activities of CDKsand cytokines under the same experimental low concentration conditions.

As shown in FIG. 6, similar to the observation shown in the Examples 1,2 and 4, LPS-stimulated increases of the production of IL-1β and IL-6were significantly inhibited by exposure of the cells to bothMeisoindigo and NATURA at as low as 31.25 nM, whereas LPS-mediatedsuppression of IL-10 in the THP-1 cells were elevated almost 2 fold byboth Meisoindigo and NATURA under the similar concentrations (FIG. 6A).

In contrast, under the same exposures, both Meisoindigo and NATURAfailed to inhibit activities of cyclin dependent 2, 4 and 6, as well asthe levels of cyclin D1 (data not shown). A partial inhibition (23%) ofthose compounds was only achieved when the cells were treated with 1.5μM (48-fold higher) of either Meisoindigo or NATURA (FIG. 6B).

In addition, the effect of NATURA on glycogen synthase kinase-3β(GSK-3β), was also investigated in the current invention, since CDKinhibitors usually are also inhibitors of GSK-3β. However, no activitywas observed when the cells were exposed to NATURA at as high as 50 μM(data not shown).

Thus, the data in this example clearly shows that Meisoindigo andrelated class of molecules is able to significantly modulate variouscytokines (inhibits pro-inflammatory cytokines, and stimulateanti-inflammatory cytokines) at remarkably low concentration; where noany inhibitory effects on CDK activity is achieved. This demonstratesthat at low concentrations compared to those needed for CDK inhibition,that Meisoindigo and its derivatives primarily target, cytokines ratherthan cyclin dependent kinases. This conclusion is supported by therecently observation that Indirubin and its derivatives are not trulybiological CDK inhibitors since the inhibition of CDK by those compoundsare through physical aggregation rather than biological reaction [23].Moreover our conclusion is also supported by the clinical observationsthat total dosage of 8696 mg of Meisoindigo is needed to achieved themaximal remission of chronic myeloid leukemia (CML) [24], whereas only525 mg of the drug are needed to obtain a complete cure of theinflammatory bowel disease.

SUMMARY

THP-1 cells secreted IL-1β, IL-6, IL-8 and TNF-α, but no IL-2, IL-4,IL-10 and IL-12 after 24 hours of the stimulation of LPS while the basallevels of these cytokines were undetectable by ELISA, which isconsistent with the previous reports [25-26]. To evaluate the potentialclinical applications of a class of small molecules of derivative ofisoindigo, indigo, and indirubin (structures shown as Formulas I, II,and III) in the treatment of various inflammatory-related diseases, weexamined the regulatory effects of Meisoindigo, as examples on thesecretion and expression of pro- and anti-inflammatory cytokines in ahuman monocytic THP-1 cell model. The data is summarized in Table 2.Meisoindigo significantly inhibited secretions of pro-inflammatorycytokines IL-1β, IL-6, and TNF-α in LPS-stimulated THP-1 cells, andstimulated the secretion of regulatory cytokine IL-10, but no effectswere observed on IL-2 simply because the cells were unable to bestimulated to secrete these pro-inflammatory cytokines. The maximalreductions or stimulations of the secretions of these cytokines aresummarized in Table 1.

TABLE 1 Modulation of Meisoindigo on the secretion of pro-inflammatoryand regulatory cytokines in LPS-stimulated THP-1 cells Percentage ofMaximal Response Without Cytotoxicity TNF-α IL-1β IL-6 IL-10 Treatment(Inhibition) (Inhibition) (Inhibition) (Stimulation) LPS 100.00 ± 4.85100.00 ± 3.43 100.00 ± 9.78 −18.27 ± 10.15 LPS/Meisoindigo  49.20 ± 3.37 48.76 ± 3.68  83.51 ± 5.41 201.97 ± 11.2 

Reduction of IL-6 secretion by Meisoindigo in LPS stimulated THP-1 cellsmay be a result of the down-regulation of transcription of the cytokinegene by using a real time PCR technique. Real time PCR assay also showeda moderate inhibition of Meisoindigo on IL-15 in the LPS-stimulatedTHP-1 cells (data not shown). No such down-regulation was observed forTNF-α gene using the same technology. Although mechanisms by whichMeisoindigo and molecules of this class regulate pro- andanti-inflammatory cytokines need to be further investigated, our data inthe present invention demonstrates that this class of small molecules iscapable of modulating important cytokines related to variousinflammatory-related diseases.

During the past several years, strategies targeting pro-inflammatorycytokines have been created several protein-based agents for thetreatment of various inflammatory disorders, including TNF-α inhibitorsetaercept (ENBREL®), infliximan (REMICADE®; Centocor), adalimumab(HUMIRA®; Abbott) and IL-1 receptor antagonist KINERET®. Early stages ofclinical application of these agents indicated that these revolutionarytherapeutic agents have been an advancement in the treatment ofautoimmune diseases such as IBD, RA, and psoriasis. However, the currentinjectable protein-based therapies have associated risks, including thepotential for increased malignancies, infections and increasedcongestive heart failure [27]. Moreover, those strategies also havelimitations and are challenged by the sophisticated cytokine networksystem. Although several types of small molecules have been shown to bea specific pro-inflammatory cytokine inhibitor, such as inhibitors ofTNF-α and NF-κB, and have various advantages over the protein-basedagents, targeting a single pro-inflammatory cytokine may not be strongenough to interrupt the inflammatory pathological pathways, and thislimits their clinical efficacy.

In contrast, besides all the advantages of small molecules in clinicalapplication, such as the fact that they are easy to make and convenientto administer, most importantly the molecules claimed in the inventionnot only concurrently suppress various pro-inflammatory cytokines, i.e.,IL-1β, IL-6, and TNF-α, but also stimulate anti-inflammatory cytokineIL-10. Moreover these molecules have been demonstrated in our previouspatent to induce cell differentiation and inhibit cell proliferation athigher concentration. Thus, they provide greater clinical activity. Thisconclusion has been supported by remarkable outcomes of the efficacyachieved using Meisoindigo for the treatment of a patient with IBDwithout any side effects.

Example 6: Meisoindigo and Natura Effectively Prevents and TreatsProteinuria in NZB/F1 Mice

Animal Models:

There are at least four mouse models of lupus nephritis [28]. BothNZB×NZW F1 [29] and MRL/lpr mouse [30-31] strains spontaneously developautoimmune lupus nephritis. Female mice from the NZB×NZW F1 cross(NZB/W) develop proteinuria and only a small number (<20%) survive to 52weeks. In MLR/lpr mice, the disease develops in both males and femalesand is associated with the fas lpr mutation on the MLR background. Micedevelop significant proteinuria at 16 weeks and show significantmortality rates (about 50%) by 20 weeks [32-33]. Among these models,both MLR/lpr and NZB/W mouse models have been widely used in drugdevelopment [34-36].

To determine whether Meisoindigo and Natura effectively prevents andtreats proteinuria of lupus, NZB/W mice were used.

Materials:

Meisoindigo and Natura, were synthesized, purified andstructure-characterized by the Natrogen Therapeutics, International,Inc. Suspension of Meisoindigo and Natura were prepared weekly in 0.5%tween 20 and stored at 4° C. The drug suspensions were given orally forpurposes of the animal tests described below.

Animals:

NZB/W (New Zealand Black/New Zealand White, NZB×NZW F1 cross) femalemice were purchased from the Jackson Laboratory (Bar Harbor, Me.). Thesemice were be maintained under pathogen-free barrier conditions, inaccordance with guidelines from the American Association for theAccreditation of Laboratory Animal Care, and the Institutional AnimalCare and Use Committee of New York Medical College. The animals werehoused five per cage, and fed ad libitum, fresh tap water and commercialrodent pellets. Animal rooms were controlled at 24±2° C., with arelative humidity of 60±5%, and a 12 hr light/dark cycle (07:00-19:00hr).

Animal Treatment:

Beginning at 16 weeks of age, disease progression of the mice wasmonitored weekly by assessing proteinuria. A cohort of mice, selected at17 weeks of age, were served as the “asymptomatic normal” group (n=5).Constant proteinuria (>30 mg/dL) was detected for two consecutiveoccasions, and the kidney damage initiated (glomerular lesion >24%), thediseased mice were randomly divided into 5 groups (n=10). Group oneanimals were served as control (orally given vehicle only). Group 2 and3 animals were given Meisoindigo suspension orally by gavage at doses of25 mg/kg (0.09 mmol/kg) and 75 mg/kg (0.272 mmol/kg), once a day, 5 daysper week for 25 weeks. Group 4 and 5 animals were given Naturasuspension orally at equal molar doses as Meisoindigo above, i.e. 47 and142 mg/kg, respectively, for the same period of time. Mice weremonitored weekly for proteinuria until 44 weeks of age.

Assessment of Proteinuria:

Urine was manually expressed from each mouse on a weekly basis,collected into a sterile container and assayed for the presence ofprotein (specifically albumin), using a colorimetric method (AlbustixReagent Strips, Bayer Corporation, Elkhart, Ind.). Proteinuriaevaluations were scored as follows: grade 0.5=‘trace’ proteinuria; grade1=about 30 mg/dL; grade 2=about 100 mg/dL; grade 3=about 300 mg/dL; andgrade 4=more than 2000 mg/dL [33]. If mice achieved a grade 4 reading ontwo consecutive days, they would be euthanised.

Results

The treatments of the animals with vehicle control or with Meisoindigoand Natura at two dose levels as described above began at week 19 whenthe animals developed proteinuria at 30 mg/dL and renal lesion initiatedby histopathology. FIG. 7 shows dynamic changes with time in levels ofproteinuria in mice with different treatment regimen. Proteinuria inmice treated with vehicle elevated at week 31, and sharply increased atweek 38. In contrast, proteinuria in animals treated with bothMeisoindigo and Natura at both dose levels essentially maintained atbasil levels from week 31 to week 37, and only slightly elevated at week38. With the disease progression, the proteinuria level in animalstreated vehicle continuously and progressively increased and reachedover 1000 mg/dL at week 44 whereas the levels in two Meisoindigo treatedgroups essentially maintained at stable lower level (150+100 mg/dL atdose of 25 mg/kg, and 115+127 mg/dL at dose of 75 mg/kg, respectively).In two Natura treated groups, the proteinuria levels were alsosignificantly lower than the animals in vehicle treated group.

Example 7: Meisoindigo and Natura Remarkably Prevents Animal Death fromLupus in NZB/F1 Mice

Methods:

The materials, animals, and animal treatments were the same as Example6. Animal survival was observed and recorded during the treatment perioddaily.

Statistical Analysis:

All data are expressed as mean±SD. Statistical significance of anydifference between the control and experimental groups were determinedby the One Way ANOVA test with P value at least <0.05.

Results:

One characteristic of NZB/W mice is higher death rates as results ofdisease progression [37], thus we determined the survival rates of themice in various treated groups and non-treatment group. The dynamicsurvival rates of the mice are shown in FIG. 8. Animals Began to die atweek 38 in vehicle control group. After week 38, the death rates in thevehicle treatment group or non-treatment group were accelerated withtime. At week 48, 60% of mice died in the vehicle treated group while20% of the animals also died in two Natura treated groups. The survivalrates in two Natura treated groups were found to be statisticallysignificant higher than that of vehicle treated group (80% via 40%,p<0.001). Most importantly, all animals survived in two Meisoindigotreated groups (survival rate 100% via 40% in vehicle controlled group,p<0.001).

Example 8: Meisoindigo and Natura Effectively Prevents Renal Damage fromLupus in NZB/f1 Mice

Methods:

The materials, animals, assessment of proteinuria were the same asExample 6.

Assessment of Renal Histopathology:

Kidneys were obtained from mice studied in Examples 6 and 7 after deathto examine renal damages with the disease progression of lupus. One-halfof a kidney was fixed by overnight immersion in 10% formaldehyde andparaffin embedded. To determine the extent of renal damage, sectionswere stained with H & E and periodic acid-Schiff (PAS), and scored forpathological changes by an independent pathologist. Glomerulopathy wasscored on a 0 to 5 scale. Severity grades is as follows: 0=normal orwithin normal limits; 1=minimal or slight; 2=mild; 3=moderate; 4=marked;5=severe [33]. In addition, the histological changes for mesangialproliferation, tubular dilation, protein cast deposition inside thetubules and inflammatory cell infiltration into the interstitium werealso examined.

Results:

Normal levels of histological glomerular lesions were obtained from thekidneys of “asymptomatic mice” (week 17), and baseline glomerular renallesion levels were obtained from mice at beginning of the treatment(week 19). Progressive renal lesions were initially examined whenanimals began to die at week 38 and throughout the treatment period toassess dynamic disease severity of lupus. As shown in FIG. 9, glomerularlesion in vehicle treated animals reached maximal at week 38 andthroughout the treatment period, and over 85% of glomeruli exhibitedsevere lesions. In comparison, approximately 54% glomerular lesions inthe lower dose of Meisoindigo treated group, was observed at week 38,and week 42. However, this renal damage significantly recovered at week45, and it was almost back to the baseline level (24%). In the higherdose of Meisoindigo treated group, the only moderate glomerular lesionswere observed at week 38 (36% as compared with vehicle control 85%), andthis damage recovered even faster than that of lower dose group.Significant recovery to the baseline level occurred at week 42 (20% atweek 42, and 22% at week 45 as compared with vehicle treated group 85%).Treatment of NZB/W f1 mice with two different doses of Natura alsoshowed protection effects on renal damages from the lupus.

FIG. 10 depicts examples of histopathological changes in kidneys ofNZB/W f1 mice with various treatments. Kidney sections from vehicletreated mice showed significant glomerulosclerosis, capillary lumenobliteration, proliferative glomerulonephritis, tubular dilation withintra-tubular protein case deposition and inflammatory cellinfiltration. These histopathological changes were remarked reduced inNatura-treated mice.

Discussion and Conclusion

The results of our study in this invention demonstrate that treatmentsof lupus in NZB/W f1 mice with Meisoindigo at daily doses of 25 mg/kgand 75 mg/kg, and Natura at equal molar doses for 29 weeks were veryeffective. These treatments significantly reduced levels of proteinuria,remarkably improved animal survival rates, preserved renal functions,prevented and reversed glomerular lesions. Since NZB/W mice developnephritis, closely resembling that seen in human patients with lupusnephritis, our data strongly suggests the compounds in this inventionwill be useful in treating lupus.

REFERENCES

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What is claimed is:
 1. A method of treating an animal with lupus, themethod comprising the step of administering to the animal in need ofsuch treatment at least one compound selected from the group of:Meisoindigo, tri-acetylated glyco-Meisoindigo (pro-drug) or1-(β-D-O-triacetyl-xylopyranosyl)-isoindigo, shown as Formulas (IV),(V), and (VI) respectively,

wherein the compound is administered in an amount sufficient to treatlupus.
 2. The method according to claim 1, wherein the amountadministered is sufficient to inhibit pro-inflammatory cytokineexpression and/or stimulate anti-inflammatory cytokine expression, butthe amount is less than sufficient to substantially inhibit cyclindependent kinases.
 3. The method according to claim 1, wherein theamount administered is less than about 0.36 mmol/kg per day.
 4. Themethod according to claim 3, wherein the compound administered isMeisoindigo and the amount administered is less than about 100 mg/kg perday.
 5. The method according to claim 3, wherein the amount administeredis between 0.036 mmol/kg and 0.288 mmol/kg per day.
 6. The methodaccording to claim 4, wherein the amount administered is between 10 mgand 80 mg per day.
 7. The method according to claim 1, wherein theanimal is a human.
 8. The method according to claim 2, wherein thecompound is administered in an amount sufficient to inhibit cytokineIL-1α, β, IL-2, IL-3, IL-6, IL-7, IL-9, IL-12, IL-17, IL-18, TNF-α, LT,LIF, Oncostatin, or IFNc1α, β, γ.
 9. The method according to claim 2,where the compound is administered in an amount sufficient to stimulateexpression of cytokine IL-4, IL-10, IL-11, W-13 or TGFβ.
 10. A method oftreating lupus, the method comprising the step of administering to ananimal in need of such treatment at least a first and a second compound,wherein the first compound is selected from the group of: Meisoindigo,tri-acetylated glyco-Meisoindigo (pro-drug) or1-(β-D-O-triacetyl-xylopyranosyl)-isoindigo, shown as Formulas (IV),(V), and (VI) respectively,

wherein the second compound is selected from the group consisting of:anti-inflammatory agent, corticosteroid, immune suppressant, or biologicdrug; and wherein the first compound is administered in an amountsufficient to treat lupus.
 11. The method according to claim 10, whereinthe compounds are administered concurrently within a single composition.12. The method according to claim 10, wherein the compounds areadministered sequentially.
 13. The method according to claim 10, whereinthe second compound is selected from the group of: ibuprofen,corticosteroid, methotrexate, or BLyS-specific inhibitors.
 14. Themethod according to claim 13, wherein the BLyS-specific inhibitor isbelimumab.
 15. The method according to claim 10, wherein the firstcompound is administered in an amount less than about 0.36 mmol/kg perday.
 16. The method of claim 13, wherein the first compound isadministered in an amount between 0.036 mmol/kg and 0.288 mmol/kg perday.
 17. The method according to claim 10, wherein the animal is ahuman.
 18. The method according to claim 10, wherein the first compoundis administered in an amount sufficient to inhibit pro-inflammatorycytokine expression and/or stimulate anti-inflammatory cytokineexpression, but the amount is less than sufficient to substantiallyinhibit cyclin dependent kinases.